Impact of baby-friendly hospital initiatives on breastfeeding outcomes: Systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: The Baby-Friendly Hospital Initiative (BFHI) is a global effort promoting the Ten Steps to support breastfeeding in maternity-care facilities. AIM: This study examined the effect of BFHI on breastfeeding outcomes, focusing on initiation rates, exclusive breastfeeding durations, and factors influencing its effectiveness. METHODS: A systematic review and meta-analysis were conducted by searching nine databases (1991 to February 2024). Included studies were experimental, quasi-experimental, or observational studies, with sites implementing the full BFHI or at least three steps. Two reviewers independently screened studies, assessed risk of bias, and extracted data. Random-effects models were used for pooled results, with subgroup analyses based on BFHI status and country income level. DISCUSSION: Eighty-six studies were included. Infants in BFHI hospitals were more likely to be exclusively breastfed at ≤ 3 months (OR= 1.77; 95 % CI: 1.37-2.29) and 3-6 months (OR= 1.82; 95 % CI: 1.26-2.61). Higher rates of any breastfeeding were observed at ≤ 3 months (OR= 1.48; 95 % CI: 1.17-1.87), 3-6 months (OR= 1.75; 95 % CI: 1.18-2.61) and at > 6 months (OR= 2.34; 95 % CI: 1.04-5.27). CONCLUSIONS: BFHI implementation positively impacts breastfeeding outcomes, with both short- and long-term effects. Partial implementation also correlates with higher exclusive breastfeeding rates. Insignificant differences across income levels may reflect the limited number of studies in low-and middle- income countries. Further research with longer-term follow up is needed to confirm long-term effects.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.011 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".